Top Doctors’ Toughest Cases

Eight of this year’s top doctors reveal the most challenging cases of their careers.

By: Melissa F. Pheterson

(page 1 of 2)

Diagnoses are rarely as easy as television medical dramas make it seem. The human body has lots of doctor-confounding tricks up its sleeve, from tumors that masquerade as psychiatric problems to blood clots that hide behind heart attacks. Even when a diagnosis is relatively clear, it’s often a Herculean task requiring immense skill to solve medical problems correctly. The good news: our doctors are up to the task. Here, some of our Top Doctors recall their toughest cases—and their outcomes.

Trying to Start the Bleeding

Dr. Richard Karanfilian with his patient Richard Bartnik, who today admonishes anyone he sees with a sharp object.

Dr. Richard Karanfilian, a vascular surgeon at Sound Shore Medical Center, had just slogged through a hospital board meeting on a crisp October night in 1986. He was leaving the hospital when he heard the rescue squad call in a trauma alert and decided to wait for the ambulance. Paramedics arrived performing CPR on Richard Bartnik, an eight-year-old who had fallen face-down on a knife. “I was going out to the grill to get myself some sausages,” Bartnik recalls. “I tripped on the walkway, stood up, pulled the knife out of my neck, and screamed.” The knife had sliced open his neck above the collarbone, leaving a wound of indeterminate depth. Bleedings profusely, he entered cardiac arrest in the ambulance and had neither blood pressure nor pulse upon admission to the ER; he was in shock and unconscious, his pupils unresponsive to light.

“We immediately went into full trauma code,” says Dr. Karanfilian, who led the three-hour surgery. With the boy intubated, the surgeon slipped catheters into the veins of the thigh to administer fluids and bolster circulation; in this context, not bleeding is a bad thing.

“The first positive sign we had,” Dr. Karanfilian says, “was the resumption of bleeding from the neck wound.” He rushed Bartnik to the OR, applying as much pressure to the wound as possible, and then opened the neck with a scalpel—only to realize the wound continued under the clavicle and into the chest. It was imperative to gain access to the chest to see the extent of the damage, making haste to repair any crucial blood vessels in the knife’s path. No thoracic surgeons—those who operate on the chest—were available, so it fell to Dr. Karanfilian to think fast. He realized, with horror, that he’d have to crack open the little boy’s chest in a brute-force procedure called a median sternotomy—something he hadn’t done since residency.

“We did not have modern equipment for this,” he says, “just an antiquated instrument called a sternal splitter.” Similar to pruning shears, it split Bartnik’s chest in half. “We had no choice.” Scanning Bartnik’s organs, Dr. Karanfilian found the knife had punctured the boy’s lungs—causing them to collapse—and had severed his right subclavian artery, which supplies blood to the arms and head. It had stopped just short of fatally piercing the boy’s heart. Dr. Karanfilian’s team sutured the subclavian artery, wired the sternum together, and transferred Bartnik to the ICU, anxiously watching as his vital signs remained stable. “We weren’t sure how much brain damage had occurred,” Dr. Karanfilian says. Bartnik lay unconscious on a respirator, leaving the surgeon in despair—until the boy began to stir a week later. “It was miraculous,” Dr. Karanfilian says.

Today Bartnik, 31, works for a real-estate company in Philadelphia. “When I see anyone wielding a sharp object carelessly, I have to say something, even when it’s my mom chopping carrots in the kitchen—there’s a little residual trauma,” he says. “I’m just glad I had the good fortune to arrive at the hospital before Dr. Karanfilian left.”

Correcting A Case… in The Nick of Time

This past July, Dr. Franklin Zimmerman was trying to focus on a meeting of the medical board—but a nagging doubt gnawed at him. Earlier that evening, the Phelps Memorial cardiologist had been asked to consult on Celia Jones, a 60-year-old woman in the emergency room who complained of multiple fainting spells, tightness in the chest, and shortness of breath. The initial diagnosis from the emergency room staff was a possible heart attack, based on an abnormal EKG and elevated cardiac enzymes. Jones was frustrated and desperate for help. Two days before, she came to the ER with similar symptoms but declined the doctor’s recommendation for hospitalization after the initial evaluation was unrevealing. But her case bothered Dr. Zimmerman.

“It was very unusual that she’d had three separate episodes of fainting,” he says. “Fainting from a heart attack is due to shock or cardiac arrhythmia; that doesn’t happen three or four times, and you don’t feel well enough to go home from the ER afterwards. Something was different about this patient.”

At that evening’s meeting, he wracked his brain for the answer. Another diagnosis flashed across his mind, and he left the meeting to call in an X-ray technician for an emergency CT angiogram. His fears were confirmed when the radiologist reported a saddle embolism: a large thrombus (blood clot) that had dislodged from the legs and traveled through the right side of the heart to wedge itself into the main pulmonary arteries, obstructing flow to the lungs. The resulting danger signs—a severe drop in blood pressure, atypical chest pain, and respiratory distress—presented themselves, deceptively, as hallmarks of a heart attack. Jones promptly received a clot dissolver, Heparin, and is today on the blood thinner Coumadin.

“Celia started out as a frustrated patient and was now so grateful we had stuck with the case,” says Dr. Zimmerman. “The embolism might have been fatal had treatment not started that evening. Medicine is sometimes like a detective story, and it really is exciting when you can solve the puzzle to help a patient.”

Blasting a Basketball-Size Tumor

Oncologist Bernard Bernhardt, MD, had to jury-rig a drug treatment to try to save his patient.

On January 1, 1975, Sandor Lewis [not his real name] went to New Rochelle Hospital with back pain and a swollen testicle. Diagnosed with a seminoma, or testicular cancer, the 24-year-old newlywed became a patient of Dr. Bernard Bernhardt, a hematologist/oncologist at Sound Shore Medical Center. Dr. Bernhardt promptly arranged for the removal of the cancerous testicle—but not before it had spread to the lymph nodes in Lewis’s pelvis and abdomen. Soon, his belly swelled grotesquely with a basketball-size tumor that had displaced his liver, spleen, and pancreas as it grew into his back.

“The surgeon opened and closed him, calling it a hopeless case,” Dr. Bernhardt says. “It had pushed aside so many organs, it was impossible to resect.” Desperate to save his patient, the oncologist jury-rigged his own drug regimens by trial and error. “We treated him, grasping at straws for three doses, several weeks apart,” he says. This was Lewis’s only chance of survival, a long-shot gamble that paid off: within months, the tumor shrunk to the size of an orange. “When they went to re-operate, the cancer was dead; they had no trouble getting it out,” Dr. Bernhardt says.

Today, Lewis, 58, a corporate executive in Yonkers, remains close with his former doctor. “Bernie figured that if I was well enough to be in his tennis game, I was out of danger,” he quips. Initially told he’d never have children, Lewis today has two grown daughters. “You can call him a witch doctor, but he came up with the right potion,” Lewis says. Dr. Bernhardt takes pride in daring to create his own chemo—a life-saving therapy that was literally unprecedented. “How many times can you say that you cured a friend’s cancer?” he asks.

Rebuilding a Shattered Knee

Knee injuries are par for the course in orthopedic surgeons’ offices, but Dr. Anthony Maddalo of Phelps Memorial Hospital Center doubted he could put David Edwards back on his feet. In October 2004, the Ossining policeman, then 34, was responding to a call when he was broadsided by a cab driver with alcohol, cocaine, and marijuana in her system. Edwards felt the steering wheel pin his thigh to the seat as his lower legs were driven backwards. The result was a complete knee dislocation—with three ruptured ligaments, a meniscal tear, and severe nerve damage causing foot drop. “That’s a devastating injury, one that’s nearly impossible to fix,” Dr. Maddalo says. The nerve damage to the foot made recovery even more unlikely. “My foot was just hanging there, drooping,” Edwards says. “They didn’t know if I’d ever get sensation back to walk again.”

With a challenge this daunting, Dr. Maddalo decided on two surgeries. He performed the first surgery in late October to clear scar tissue, relieve pressure on the peroneal nerve, and reconstruct the LCL, the ligament that runs along the side of the knee joint. Three months later, a second surgery repaired both the ACL and the PCL, the bands girding the knee joint in front and in back. The post-operative rehab determined the surgery sequence: LCL repair requires immobilization with a brace, while ACL and PCL repair calls for rapid movement—aggressive physical therapy with electric pulses sent through the leg. “First I felt nothing, then a flicker,” Edwards says. “And, slowly but surely, I could move my foot one inch.” Eighteen months of therapy restored sensation, allowing him to flex his ankle. Edwards not only learned to walk again, he rejoined the force in mid-2006. “I wasn’t ready to retire,” he says. Dr. Maddalo is still floored: “I’ve never seen such a complete recovery.”